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Pump Position Impacts HeartMate II Left Ventricular Assist Device Thrombosis

Kilic, Ahmet*; Ransom, John; Maltais, Simon; Sun, Benjamin§; Entwistle, John W. III; Bailey, Stephen; John, Ranjit#; Klodell, Charles T.**; Gregoric, Igor††; Sheridan, Brett‡‡; Chuang, Joyce§§; Farrar, David J.§§; Sundareswaran, Kartik§§; Adamson, Robert¶¶

doi: 10.1097/MAT.0000000000000840
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The PREVENtion of HeartMate II pump Thrombosis through clinical management (PREVENT) study was a multicenter, prospective investigation to evaluate the rate of pump thrombosis (PT) with adoption of a uniform set of surgical and medical practices for left ventricular assist device implantation. We sought to quantify pump position at baseline and retrospectively define a pump position associated with poor clinical outcomes. Chest x-rays at baseline were prospectively obtained per protocol. Pump pocket depth, inflow cannula (IC) angle relative to the pump, and IC angle relative to the vertical were measured. Pumps falling in the tail-ends of the IC angle and pump pocket depth distributions were categorized as having an extreme pump position within the PREVENT study. Patients with extreme pump position had a significantly higher risk of confirmed and suspected PT, hemolysis, and elevated lactate dehydrogenase. In a multivariable analysis of survival free of confirmed PT, extreme pump position was an independent risk factor (hazard ratio = 3.6; 95% confidence interval = 1.5–8.9; p = 0.006) when adjusting for differences in pump speed and anticoagulation level. Our analysis shows that HeartMate II pump position at implant can significantly impact event-free survival and the incidence of adverse events at 6 months.

From the *Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland

Baptist Health Heart and Transplant Institute, Little Rock, Arkansas

Mayo Clinic, Rochester, Minnesota

§Minneapolis Heart Institute, Minneapolis Heart Institute, Minnesota

Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania

Department of Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania

#Department of Surgery, University of Minnesota, Minneapolis, Minnesota

**Department of Surgery, University of Central Florida, Gainesville, Florida

††The University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Houston, Texas

‡‡California Pacific Medical Center, San Francisco, California

§§Abbott, Pleasanton, California

¶¶Sharp Memorial Hospital, San Diego, California.

The PREVENT study was sponsored and conducted by Thoratec Corporation (now Abbott). The clinical trial registry number is NCT02158403.

Disclosure: A. Kilic is a consultant for Abbott. S. Maltais is a consultant for Abbott, Heartware. B. Sun is a consultant for Abbott, Sunshine Heart. S. Bailey is a consultant for Abbott, Edwards. R. John received research support from Abbott. B. Sheridan is a consultant for Abbott. J. Chuang, D.J. Farrar, and K. Sundareswaran are employees of Abbott. R. Adamson is a consultant for Abbott. The other authors have no conflicts of interest to report.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.asaiojournal.com).

Correspondence: Ahmet Kilic, MD, Johns Hopkins Hospital, 1800 Orleans Street, Zayed 7107, Baltimore, MD 21287. Email: akilic2@jhmi.edu.

Copyright © 2019 by the American Society for Artificial Internal Organs